Advanced MR imaging of bone marrow: quantification of signal alterations on T1-weighted Dixon and T2-weighted Dixon sequences in red marrow, yellow marrow, and pathologic marrow lesions

  • Chayanit SasipongananEmail author
  • Kevin Yan
  • Parham Pezeshk
  • Yin Xi
  • Avneesh Chhabra
Scientific Article



To quantify and compare signal intensity (SI) changes on T1-weighted (W) and T2W Dixon imaging in yellow marrow, red marrow, and bone marrow lesions.

Materials and methods

A total of 141 patients (77 controls, 64 lesions—33 benign, 31 malignant) between January 2016 and December 2017 were retrospectively identified. For the control group, fixed 2-cm2 region of interests (ROI) were drawn at L5, bilateral ilium and femurs on in-phase and opposed-phase T1W and T2W Dixon images. For the lesion group, ROIs of best fit were drawn around each lesion on in-phase and opposed-phase T2W Dixon images. SI changes between in-phase and opposed phase maps for each group were compared. Inter-reader analysis was performed.


Yellow marrow exhibited smaller SI changes as compared to red marrow on both T1W and T2W Dixon imaging at all locations (p < 0.0001) except at L5 on T2W Dixon imaging (p = 0.206). Both benign and malignant lesions showed significantly smaller SI changes as compared to both yellow (p = 0.0087, p < 0.0001) and red marrow (p = 0.0004, p < 0.0001) on T2W Dixon imaging. Malignant lesions exhibited smaller SI change as compared to benign lesions on T2W Dixon imaging (p = 0.0005). Signal intensity loss on both red and yellow marrow were smaller on T1W Dixon as compared to T2W Dixon (0.49–0.64, 0.27–0.31 vs. 0.70–0.74, 0.48–0.71). Inter-reader agreements were excellent (0.91–0.97).


SI change calculated from T2-weighted Dixon imaging can adequately differentiate between yellow marrow, red marrow, and osseous lesions, both benign and malignant.


Bone Marrow Bone diseases Magnetic resonance imaging Adult 



Chemical shift-selective fat saturation


Chemical shift imaging


Region of interest


Signal intensity


Standard deviation


Short inversion time inversion-recovery




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Poulton TB, Murphy WD, Duerk JL, Chapek CC, Feiglin DH. Bone marrow reconversion in adults who are smokers: MR imaging findings. AJR Am J Roentgenol. 1993;161(6):1217–21.CrossRefGoogle Scholar
  2. 2.
    Vogler JB 3rd, Murphy WA. Bone marrow imaging. Radiology. 1988;168(3):679–93.CrossRefGoogle Scholar
  3. 3.
    Howe BM, Johnson GB, Wenger DE. Current concepts in MRI of focal and diffuse malignancy of bone marrow. Semin Musculoskelet Radiol. 2013;17(2):137–44.CrossRefGoogle Scholar
  4. 4.
    Douis H, Davies AM, Jeys L, Sian P. Chemical shift MRI can aid in the diagnosis of indeterminate skeletal lesions of the spine. Eur Radiol. 2016;26(4):932–40.CrossRefGoogle Scholar
  5. 5.
    Kim YP, Kannengiesser S, Paek MY, et al. Differentiation between focal malignant marrow-replacing lesions and benign red marrow deposition of the spine with T2*-corrected fat-signal fraction map using a three-echo volume interpolated breath-hold gradient echo Dixon sequence. Korean J Radiol. 2014;15(6):781–91.CrossRefGoogle Scholar
  6. 6.
    Lee SH, Lee YH, Hahn S, Suh JS. Fat fraction estimation of morphologically normal lumbar vertebrae using the two-point mDixon turbo spin-echo MRI with flexible echo times and multipeak spectral model of fat: comparison between cancer and non-cancer patients. Magn Reson Imaging. 2016;34(8):1114–20.CrossRefGoogle Scholar
  7. 7.
    Zajick DC Jr, Morrison WB, Schweitzer ME, Parellada JA, Carrino JA. Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow. Radiology. 2005;237(2):590–6.CrossRefGoogle Scholar
  8. 8.
    Kirchgesner T, Perlepe V, Michoux N, Larbi A, Vande Berg B. Fat suppression at 2D MR imaging of the hands: Dixon method versus CHESS technique and STIR sequence. Eur J Radiol. 2017;89:40–6.CrossRefGoogle Scholar
  9. 9.
    Del Grande F, Santini F, Herzka DA, et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics. 2014;34(1):217–33.CrossRefGoogle Scholar
  10. 10.
    Dixon WT. Simple proton spectroscopic imaging. Radiology. 1984;153(1):189–94.CrossRefGoogle Scholar
  11. 11.
    Ma J. Dixon techniques for water and fat imaging. J Magn Reson Imaging. 2008;28(3):543–58.CrossRefGoogle Scholar
  12. 12.
    Maeder Y, Dunet V, Richard R, Becce F, Omoumi P. Bone marrow metastases: T2-weighted Dixon spin-echo fat images can replace T1-weighted spin-echo images. Radiology. 2018;286(3):948–59.CrossRefGoogle Scholar
  13. 13.
    Yoo HJ, Hong SH, Kim DH, et al. Measurement of fat content in vertebral marrow using a modified Dixon sequence to differentiate benign from malignant processes. J Magn Reson Imaging. 2017;45(5):1534–44.CrossRefGoogle Scholar
  14. 14.
    Suh CH, Yun SJ, Jin W, Park SY, Ryu CW, Lee SH. Diagnostic performance of in-phase and opposed-phase chemical-shift imaging for differentiating benign and malignant vertebral marrow lesions: a meta-analysis. AJR Am J Roentgenol. 2018;211(4):W188–97.CrossRefGoogle Scholar
  15. 15.
    Pokharel SS, Macura KJ, Kamel IR, Zaheer A. Current MR imaging lipid detection techniques for diagnosis of lesions in the abdomen and pelvis. Radiographics. 2013;33(3):681–702.CrossRefGoogle Scholar

Copyright information

© ISS 2019

Authors and Affiliations

  1. 1.Radiology DepartmentUT Southwestern Medical CenterDallasUSA
  2. 2.Orthopedics DepartmentUT Southwestern Medical CenterDallasUSA

Personalised recommendations